West Midlands Renal Network
West Midlands Renal Network Board
Date: Thursday 10th February 2011
Venue: The Hilton Hotel Bromsgrove, Birmingham Road, Bromsgrove B61 0JB
Minutes
Present:
Paul Jennings (Chair) NHS Warwickshire
Nanette Grant WM Renal Network
Hugh Rayner WM Renal Network
Rob Lusuardi WM Specialised Commissioning Team
Carol Willis Heart of England FT
Loulla Constantinou WM Renal Network
David Milford Birmingham Children’s Hospital
Pat Simoyi Birmingham CHC
Shiva Kumar Dudley Group of Hospitals
Paula Mitchell University Hospital Birmingham FT
Liz Simpson Worcestershire Acute Hospitals
Kerry Tomlinson University Hospital North Staffordshire
Judith Sidaway Dudley KPA
Lisa Harrigan University Hospital Coventry & Warwickshire
Kay Wilkinson University Hospital Coventry & Warwickshire
Brian Williams University Hospital Coventry & Warwickshire
Paul Carmichael Royal Wolverhampton Hospital NHS Trust
Nick Flint QE KPA
Dawn Roach QE KPA
Mary Bosworth HoBtPCT
Inese Edgcumbe University Hospital Birmingham FT
Julie Potter Dudley Group of Hospitals
Claire Ellis Birmingham CHC
Helen Spooner Royal Wolverhampton Hospital
Apologies:
Saj Kahrod BEN PCT
Jonathan Howell WM Specialised Commissioning Team
Simon Fletcher University Hospital Coventry & Warwick
Paul Cockwell University Hospital Birmingham FT
Jeremy Shearman South Warwickshire FT
Heather Woodward Royal Wolverhampton Hospital NHS Trust
Shirley Weston-Hayles Sandwell PCT
Martin Ferring Worcestershire Acute Hospitals
Stephen Spencer Worcestershire Acute Hospitals
Denis Cawdron National Kidney Federation
Carol Sidaway Kidney Patient Association
William Withers Patient Representative
Waheed Saleem BEN PCT
John Sharman Hereford Hospital Trust
Clair Huckerby Dudley PCT
Liz Cropper University Hospital North Staffordshire
Rajib Pal South Birmingham PCT
Sue Weaver Kidney Patient Association
Indranil Dasgupta Heart of England FT
Tracey Jones NHS Telford & Wrekin PCT
Neil Griffin University Hospital Coventry Warwickshire
Vijay Suresh Heart of England FT
Jane Parker Dudley Group of Hospitals
ACTION
1. / Welcome & Introductions /2. / Minutes of Previous Meeting
The Minutes were agreed as a true and accurate record of the meeting held on 9th September 2010.
3. / Matters Arising
· Repatriation of CKD Patients
The CKD pathway is being reviewed and a specification is being drafted as part of the Renal QIPP work.
· Peer Review
The Peer Review Quality Requirements are now over 3 years old; the guidelines are being reviewed and an approach will be agreed for 2011/12 at a meeting on Friday 18th February.
· Patient Letters
A discussion was had regarding the use of patient letters as a mechanism for informing patients about the outcome of their outpatient appointments.
This is a system implemented within HEFT as a standard procedure for all clinicians and it was suggested this be included within contracts for all providers.
Dr Kumar advised that he has implemented this within DGOH and it is generally preferred by new patients; patients are offered a choice as to whether they receive the letters.
Members of the Patient & Carers Forum who were in attendance felt patients would benefit from receiving instant, up to date information about their condition.
Concerns were raised by providers regarding the level of detail included within the letters which are sent to patients as, if they are to be a duplication of the letter sent to GPs, this can on occasion be extremely detailed. Patients and carers in attendance felt that no information should be withheld from patients.
Administrative costs were also raised as a potential issue although it was not felt these would be extensive; PJ felt the debate should be an ethical one as opposed to financial as the impact would be minimal.
HR felt it should be up to the patient as to whether letters are sent to them. No agreement was reached on the principle of sending letters to patients.
4. / Patient Transport Services
NF reported issues identified from transport audits undertaken at UHB. NF felt it needed to be a higher priority in the network’s agenda. NF gave examples of patients waiting for transport and the long delays involved and felt these issues need to be addressed through better planning by service providers and transport providers.
JS advised long waiting times are an issue at DGOH; the contract there is with Ambuline and a number of the vehicles used are in a poor state. There are plans in place to replace these at the end of the month.
BCH has found it cheaper to reimburse parents for driving the children to the hospital. Their more flexible approach also allows for the use of taxis which is a cheaper option for some.
NG reported on the Southend project in which they have undertaken a number of things in order to improve PTS including:
1. Review eligibility criteria for PTS.
2. Cohorting of patients.
3. Rescheduled journeys.
This resulted in an overall cost saving and improved outcomes for patients.
Concerns were expressed as to having eligibility criteria for transport and driving themselves in may be dangerous if the patient is unwell.
PCTs hold the funding for transport and there is no clear consistency contractually. It would be preferable to have more rigorous standards included within the contracts and to include patients in the contract discussions.
Part of the social care review in the autumn will include the use of personal health budgets and thus we should wait for the outcome of this before considering its use for PTS.
5. / NHS White Paper: Transitional Plan Update
PJ provided an update on the White Paper and advised we will see significant changes to the NHS since 1948. PJ outlined the changes as follows:
· Financial responsibility will sit with clinical responsibility in primary care.
· All providers will be regulated by the same regulator.
· Transfer of resources to central care.
· NHS faces reduction of 15-20%.
· No pay rise for staff.
· Changes in pensions, retirement and salaries.
· SHA to be abolished in March 2012.
· The focus will be on commissioning.
· NHS CB will have clear outcomes set by the state.
· GPs will be performance managed.
· Monitor will regulate the economy
· CQC will licence organisations and regulate/inspect the system.
· Clusters are being formed to replace PCTs.
PJ advised the focus will be in quality and outcomes and thus we need to do the best we can with the resources available.
DM felt quality would suffer as renal uses advanced technology, investigations and drugs which cost money.
NF felt inefficiencies exist and poor quality wastes money.
6. / Renal Commissioning Update
Operating Framework – annual guidelines have been released showing the regulators for the coming year with prices and targets.
The changes include:
· A 2 year transition process for tariff.
· Best Practice tariff which awards vascular access over catheters.
· 100% of tariff will be awarded for vascular access, 75% if no vascular access.
· Count and pay against sessions.
Providers will report on 9 mandatory items. Commissioners have asked for additional information to be collected which will be discussed at contract meetings, along with exception reporting for patients not dialysing for 3x4 sessions.
Over the next year every session will therefore have 9-15 items to be reported on.
If appropriate data is not submitted providers will only receive 75% payment as it will be classed as not being best practice.
The West Midlands will pay for 3 sessions per week on HHD with a proportionate payment for anything above this. Utility costs will be paid by providers and conversion costs will not continue to be funded next year.
Clinical Metrics – The metrics has been agreed the issue now is how much effort it is to collect and compare.
Action 1: An email will be sent to data leads in order for them to review the ease of collecting this data. / LC
7. / QIPP Update
Satellite Unit Procurement - The Specialised Commissioning Team agreed to tender for 2 satellite units, UHCW and UHNS.
Organs for Transplant CQUIN – work is being done to increase organ donation by 50%
End of Life Care/EPO – to add to next meeting agenda.
Home therapies – RL thanked everyone for their efforts at increasing home therapies. 80 patients are now on HHD with PD also increasing.
In line with QIPP, plans are in place to change the way in which home therapies are commissioned. The pathway will be split into two as follows:
Level One – Increase in Home Therapies
Level Two – Set up
KT expressed concerns as Consultants had not agreed to either of the levels. There were strong objections to tendering the service at level one but also reservations to level two. NG advised that following the meeting with clinicians Level One will no longer be tendered but we will develop a specification and pathway to be implemented within contracts. Level Two will be undertaken via a formal tender process.
RL explained that Level 2 involved bulk buying of equipment, consumables etc to make it more cost effective.
Interactive Session
An interactive session followed where two points were considered:
(i) Identify core elements for delivering home therapies, and
(ii) Give 4-6 quality measures to performance manage
The outcome from the interactive session is to produce a pathway which will be circulated as part of the Home Therapies programme. / NG
8. / Any Other Business
Holiday Dialysis – All holiday dialysis taking place within the UK will be funded by the SCT and subject to tariff from the 1st April 2011. Private providers should only be used as a last resort and discussions are ongoing with NHS Kidney Care regarding their fees. Outside of the UK providers are advised to follow guidelines outlined in the DH policy “Temporary Dialysis Away from Base”. Patients should not be restricted on how frequently they go on holiday but should one holiday be for a period of 3 months or more there should be a clinical discussion with the patient about the management of their care.
Emergency Bikers – Leaflets were handed out on a free service to the NHS. This service is being used at Worcester and thought to be very efficient.
9. / Dates of future meetings:
Thursday 12th May, 10am at The Village Hotel, Walsall
Thursday 8th September, 10am at The Hilton Hotel, Bromsgrove
WMRN Board 100211 1